Wake-up test during major spinal surgery under Remifentanil balanced anaesthesia

Damage to spinal cord and subsequent neurological deficit is a recognised complication of major spinal surgery. It may be produced by a number of causes, not last excessive stretching when surgical in- strumentation is positioned; it is easy to under- stand that early intraoperative warning of poten- tial damage is highly desiderable. Wake-up test is a simple, safe and reliable method of recognition of such a complication, allowing rapid neurological recovery by reduc- tion of spinal distraction. Remifentanil belongs to a new pharmacoki- netic class of opioids (EMO: Esterase Metabolised Opioid) undergoing rapid biotrans- formation to minimally active metabolites, show- ing a short and predictable duration of action with no effect of accumulation. Authors describe a first 10 patient series sub- jected to wake-up-test during spinal surgery un- der remifentanil balanced anaesthesia. The pro- tocol the authors set up allowed a very rapid in- traoperative neurological examination (in aver- age less than 5 min), without pain and/or dis- agreement for the patient and no complication related to the test was observed. Authors con- clude that the use of Remifentanil for intraopera- tive awakening during major spinal surgery seems to be a safe, reliable and pratictical method to detect very quickly any potential neu- rological damage during the operation.